Healthcare Provider Details

I. General information

NPI: 1659545168
Provider Name (Legal Business Name): LYNN MARIE GROSULAK LCPC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2008
Last Update Date: 11/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 GRAND AVE SUITE 6
BILLINGS MT
59101-5852
US

IV. Provider business mailing address

PO BOX 20794
BILLINGS MT
59104-0794
US

V. Phone/Fax

Practice location:
  • Phone: 406-855-9446
  • Fax: 406-294-0967
Mailing address:
  • Phone: 406-855-9446
  • Fax: 406-294-0967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1114 LCPC
License Number StateMT

VIII. Authorized Official

Name: LYNN MARIE GROSULAK
Title or Position: OWNER
Credential: LCPC
Phone: 406-855-9446